Study of NOTES-TME Versus L-LAR in Rectal Cancer

NCT ID: NCT02550769

Last Updated: 2021-11-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

116 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-04-30

Study Completion Date

2021-06-30

Brief Summary

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INTRODUCTION: Transanal TME (T-TME) combined with laparoscopy, called hybrid-NOTES, is a less invasive procedure that responds to some of the limitations of the rectal laparoscopic approach.

MAIN OBJECTIVE: To analyze that the T-TME gets a faster recovery due to a lower conversion rate to open surgery than laparoscopic low anterior resection (L-LAR) in rectal cancer with the same pathological, functional and oncologic results.

METHODOLOGY: A prospective multicenter randomized controlled study of patients with rectal cancer that, were randomized in the T-TME- and L-LAR group. The main variables are: general morbidity, anastomotic dehiscence, conversion rate to open surgery and hospital stay. The sample calculation is 58 patients per group.

Detailed Description

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INTRODUCTION: The laparoscopic total mesorectal excision (TME) has provided better patient recovery with less morbidity and shorter hospital stay compared with open surgery. However in laparoscopic low rectal surgery, overall conversion to open surgery is around 20%. Transanal TME (T-TME) combined with laparoscopy, called hybrid-NOTES, is a less invasive procedure that responds to some of the limitations of the rectal laparoscopic approach.

MAIN OBJECTIVE: To analyze that the T-TME gets a faster recovery due to a lower conversion rate to open surgery than laparoscopic low anterior resection (L-LAR) in rectal cancer with the same pathological, functional and oncologic results.

METHODOLOGY: A prospective multicenter randomized controlled study of patients diagnosed with adenocarcinoma of the rectum that after inclusion and exclusion criteria, were randomized in the T-TME- and L-LAR group. The main variables are: general morbidity, anastomotic dehiscence, conversion rate to open surgery and hospital stay. The other variables studied were: demographic, surgical, pathological, 30-day morbidity and mortality, quality of life and oncologic results. The sample calculation is 53 patients per group. With an estimated loss of 10%, the final number will be 116 patients.

Conditions

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Rectal Cancer

Keywords

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Transanal NOTES Transanal TME Laparoscopic Low Anterior Resection Surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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TRANSANAL TOTAL MESORECTAL EXCISION

Transanal approach of total mesorectal excision.

Group Type EXPERIMENTAL

TRANSANAL TOTAL MESORECTAL EXCISION

Intervention Type PROCEDURE

The technique begins with the TEO equipment and a purse string 1 cm distal to the tumor. The dissection progresses in the posterior part until the laparoscopic TME field is reached. After the section of the rectum and TME transanal dissection, the anvil of the circular mechanical stapler is introduced through the TEO rectoscope. In the laparoscopic field, the mesosigma is sectioned at the point where the colon section is to be performed. The TEO rectoscope is withdrawn, and the bag containing the specimen is removed through the anus. The stapler is inserted. From the laparoscopic field, the strings of the purse are tightened and the purse is closed around the rectal stump with a clip. Then the stapler are joined to perform the anastomosis and a loop ileostomy is placed in the right flank.

Laparoscopic-LAR

Type of surgical intervention as control group: Laparoscopic low anterior resection with total mesorectal excision for rectal cancer

Group Type ACTIVE_COMPARATOR

Laparoscopic-LAR

Intervention Type PROCEDURE

Standard laparoscopic low anterior resection of the rectum with total mesorectal excision and colorectal anastomosis

Interventions

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TRANSANAL TOTAL MESORECTAL EXCISION

The technique begins with the TEO equipment and a purse string 1 cm distal to the tumor. The dissection progresses in the posterior part until the laparoscopic TME field is reached. After the section of the rectum and TME transanal dissection, the anvil of the circular mechanical stapler is introduced through the TEO rectoscope. In the laparoscopic field, the mesosigma is sectioned at the point where the colon section is to be performed. The TEO rectoscope is withdrawn, and the bag containing the specimen is removed through the anus. The stapler is inserted. From the laparoscopic field, the strings of the purse are tightened and the purse is closed around the rectal stump with a clip. Then the stapler are joined to perform the anastomosis and a loop ileostomy is placed in the right flank.

Intervention Type PROCEDURE

Laparoscopic-LAR

Standard laparoscopic low anterior resection of the rectum with total mesorectal excision and colorectal anastomosis

Intervention Type PROCEDURE

Other Intervention Names

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Laparoscopic Low Anterior Resecion of the rectum

Eligibility Criteria

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Inclusion Criteria

* Age over 18 years
* Patients with rectal cancer stage: cT1-2-3, cN0-1, cM0.
* Tumor equal or below 10 cm from the anal verge, candidates to (ETM) low anterior resection and anastomosis, with or without preoperative chemo-radiotherapy.
* Adenocarcinoma of low or moderate differentiation
* ASA I, II, III.

Exclusion Criteria

* Do not sign informed consent
* Pregnant patients
* Liver cirrhosis
* Undifferentiated adenocarcinoma.
* cT4
* Metastatic disease (M1)
* chronic renal failure on dialysis
* ASA IV
* BMI \<18 and\> 35 kg / m2
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Corporacion Parc Tauli

OTHER

Sponsor Role lead

Responsible Party

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Xavier Serra-Aracil

Medical Doctor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Serra-Aracil Xavier, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Corporacio Parc Tauli. Parc Tauli University Hospital

Locations

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Parc Tauli University Hospital

Sabadell, Barcelona, Spain

Site Status

Countries

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Spain

References

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Serra-Aracil X, Mora-Lopez L, Casalots A, Pericay C, Guerrero R, Navarro-Soto S. Hybrid NOTES: TEO for transanal total mesorectal excision: intracorporeal resection and anastomosis. Surg Endosc. 2016 Jan;30(1):346-54. doi: 10.1007/s00464-015-4170-5. Epub 2015 Mar 27.

Reference Type BACKGROUND
PMID: 25814073 (View on PubMed)

Serra-Aracil X. [Transanal total mesorectal excision]. Cir Esp. 2014 Apr;92(4):221-2. doi: 10.1016/j.ciresp.2014.01.002. Epub 2014 Feb 24. No abstract available. Spanish.

Reference Type BACKGROUND
PMID: 24576748 (View on PubMed)

Serra-Aracil X, Zarate A, Bargallo J, Gonzalez A, Serracant A, Roura J, Delgado S, Mora-Lopez L; Ta-LaTME study Group. Transanal versus laparoscopic total mesorectal excision for mid and low rectal cancer (Ta-LaTME study): multicentre, randomized, open-label trial. Br J Surg. 2023 Jan 10;110(2):150-158. doi: 10.1093/bjs/znac324.

Reference Type DERIVED
PMID: 36224406 (View on PubMed)

Serra-Aracil X, Zarate A, Mora L, Serra-Pla S, Pallisera A, Bonfill J, Bargallo J, Pando A, Delgado S, Balleteros E, Pericay C. Study protocol for a multicenter prospective controlled and randomized trial of transanal total mesorectal excision versus laparoscopic low anterior resection in rectal cancer. Int J Colorectal Dis. 2018 May;33(5):649-655. doi: 10.1007/s00384-018-2996-8. Epub 2018 Mar 16.

Reference Type DERIVED
PMID: 29546560 (View on PubMed)

Other Identifiers

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NOTES-LRAB_TAU-2015

Identifier Type: -

Identifier Source: org_study_id